Healthcare Provider Details

I. General information

NPI: 1083346050
Provider Name (Legal Business Name): AUSTIN MONTGOMERY BREKKE FNP, DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2022
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17121 E 8TH AVE
SPOKANE VALLEY WA
99016-8556
US

IV. Provider business mailing address

18112 E 11TH AVE
GREENACRES WA
99016-8657
US

V. Phone/Fax

Practice location:
  • Phone: 208-819-2183
  • Fax: 208-209-6063
Mailing address:
  • Phone: 509-570-2695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61312368
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number74029
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: